Bilateral versus Unilateral Autologous Free Flap Reconstruction in Unilateral Breast Cancers: Impact of Comparisons between PREDICT and BODICEA Scores
Association of Breast Surgery ePoster Library. Russell V. 05/15/17; 166245; P091
Dr. Victoria Russell
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Abstract
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Introduction:
For patients with sporadic breast cancer, rates of contralateral cancer are low (0.7%/annum) and there is no evidence to suggest contralateral prophylactic mastectomy (CPM) offers survival advantage. However, CPM with autologous reconstruction has major resource implications. The aim was to review the implications of bilateral reconstructive surgery in patients with unilateral breast cancer.
Methods:
Based on age, diagnostic mode and histopathological factors PREDICT scores were retrospectively calculated for n=73 consecutive patients undergoing mastectomy and autologous reconstruction. Based on family history data, BODICEA contralateral breast cancer risk was also calculated. Data was analysed using SPSS (v20) to correlate PREDICT versus BODICEA scores to identify the proportion of patients with a contralateral risk of >30% (NICE criteria for CPM).
Results:
Of 73 consecutive patients, 62 had unilateral mastectomy and autologous reconstruction and 11 had bilateral surgery. Of the total, n=10 patients had a contralateral risk score of >30% and of those who underwent unilateral surgery only (n=62), n=4 patients had a contralateral score of >30% and would have fulfilled NICE criteria for CPM (5-year survival >80%). There was no correlation between BODICEA and PREDICT scores (5/10 years p=0.735). Interestingly, of patients undergoing bilateral surgery (n=11), n=4 were for patient requests [mean BODICEA score=20.0%, range 12.5-23.5%] and the remainder were for confirmed BRCA1/2 mutations.
Conclusion:
In the absence of prospective scoring of contralateral risk certain patients undergoing bilateral mastectomy and reconstruction without significant benefit, and a proportion of patients with good prognoses and substantial contralateral risk are not undergoing immediate bilateral surgery.
For patients with sporadic breast cancer, rates of contralateral cancer are low (0.7%/annum) and there is no evidence to suggest contralateral prophylactic mastectomy (CPM) offers survival advantage. However, CPM with autologous reconstruction has major resource implications. The aim was to review the implications of bilateral reconstructive surgery in patients with unilateral breast cancer.
Methods:
Based on age, diagnostic mode and histopathological factors PREDICT scores were retrospectively calculated for n=73 consecutive patients undergoing mastectomy and autologous reconstruction. Based on family history data, BODICEA contralateral breast cancer risk was also calculated. Data was analysed using SPSS (v20) to correlate PREDICT versus BODICEA scores to identify the proportion of patients with a contralateral risk of >30% (NICE criteria for CPM).
Results:
Of 73 consecutive patients, 62 had unilateral mastectomy and autologous reconstruction and 11 had bilateral surgery. Of the total, n=10 patients had a contralateral risk score of >30% and of those who underwent unilateral surgery only (n=62), n=4 patients had a contralateral score of >30% and would have fulfilled NICE criteria for CPM (5-year survival >80%). There was no correlation between BODICEA and PREDICT scores (5/10 years p=0.735). Interestingly, of patients undergoing bilateral surgery (n=11), n=4 were for patient requests [mean BODICEA score=20.0%, range 12.5-23.5%] and the remainder were for confirmed BRCA1/2 mutations.
Conclusion:
In the absence of prospective scoring of contralateral risk certain patients undergoing bilateral mastectomy and reconstruction without significant benefit, and a proportion of patients with good prognoses and substantial contralateral risk are not undergoing immediate bilateral surgery.
Introduction:
For patients with sporadic breast cancer, rates of contralateral cancer are low (0.7%/annum) and there is no evidence to suggest contralateral prophylactic mastectomy (CPM) offers survival advantage. However, CPM with autologous reconstruction has major resource implications. The aim was to review the implications of bilateral reconstructive surgery in patients with unilateral breast cancer.
Methods:
Based on age, diagnostic mode and histopathological factors PREDICT scores were retrospectively calculated for n=73 consecutive patients undergoing mastectomy and autologous reconstruction. Based on family history data, BODICEA contralateral breast cancer risk was also calculated. Data was analysed using SPSS (v20) to correlate PREDICT versus BODICEA scores to identify the proportion of patients with a contralateral risk of >30% (NICE criteria for CPM).
Results:
Of 73 consecutive patients, 62 had unilateral mastectomy and autologous reconstruction and 11 had bilateral surgery. Of the total, n=10 patients had a contralateral risk score of >30% and of those who underwent unilateral surgery only (n=62), n=4 patients had a contralateral score of >30% and would have fulfilled NICE criteria for CPM (5-year survival >80%). There was no correlation between BODICEA and PREDICT scores (5/10 years p=0.735). Interestingly, of patients undergoing bilateral surgery (n=11), n=4 were for patient requests [mean BODICEA score=20.0%, range 12.5-23.5%] and the remainder were for confirmed BRCA1/2 mutations.
Conclusion:
In the absence of prospective scoring of contralateral risk certain patients undergoing bilateral mastectomy and reconstruction without significant benefit, and a proportion of patients with good prognoses and substantial contralateral risk are not undergoing immediate bilateral surgery.
For patients with sporadic breast cancer, rates of contralateral cancer are low (0.7%/annum) and there is no evidence to suggest contralateral prophylactic mastectomy (CPM) offers survival advantage. However, CPM with autologous reconstruction has major resource implications. The aim was to review the implications of bilateral reconstructive surgery in patients with unilateral breast cancer.
Methods:
Based on age, diagnostic mode and histopathological factors PREDICT scores were retrospectively calculated for n=73 consecutive patients undergoing mastectomy and autologous reconstruction. Based on family history data, BODICEA contralateral breast cancer risk was also calculated. Data was analysed using SPSS (v20) to correlate PREDICT versus BODICEA scores to identify the proportion of patients with a contralateral risk of >30% (NICE criteria for CPM).
Results:
Of 73 consecutive patients, 62 had unilateral mastectomy and autologous reconstruction and 11 had bilateral surgery. Of the total, n=10 patients had a contralateral risk score of >30% and of those who underwent unilateral surgery only (n=62), n=4 patients had a contralateral score of >30% and would have fulfilled NICE criteria for CPM (5-year survival >80%). There was no correlation between BODICEA and PREDICT scores (5/10 years p=0.735). Interestingly, of patients undergoing bilateral surgery (n=11), n=4 were for patient requests [mean BODICEA score=20.0%, range 12.5-23.5%] and the remainder were for confirmed BRCA1/2 mutations.
Conclusion:
In the absence of prospective scoring of contralateral risk certain patients undergoing bilateral mastectomy and reconstruction without significant benefit, and a proportion of patients with good prognoses and substantial contralateral risk are not undergoing immediate bilateral surgery.
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